摘要：
目的 探讨体感诱发电位(SEP)、经头颅电刺激运动诱发电位(TES-MEP)与自发肌电图(EMG)监测技术在胸、腰、骶椎结核患者行结核病灶清除及植骨内固定术中联合应用的价值.方法 对27例胸椎(T2～L2)结核患者行结核病灶清除及植骨内固定术中SEP联合TES-MEP监护,11例腰椎或腰骶椎结核患者(L3～S1)行术中SEP联合TES-MEP和自发EMG监护.通过观察SEP及TES-MEP波幅及潜伏期变化来判断患者感觉和运动通路状况,通过自发EMG反应来精确定位受激惹的神经根.结果 ①SEP监测成功率100％(38/38),TES-MEP监测成功率92.1％(35/38),联合监测成功率92.1％ (35/38);SEP阳性率7.9％(3/38),TES-MEP阳性率28.9％ (11/38);SEP联合TES-MEP均为阳性的比率5.3％ (2/38);SEP阴性,而TES-MEP阳性的比率为23.7％(9/38);SEP阳性,而TES-MEP阴性的比率为2.6％(1/38);联合监测假阴性率为0％ (0/38),假阳性率为5.3％(2/38),术后神经功能损伤2例.②腰椎或腰骶椎结核手术中,自发EMG监测能准确判断腰椎神经根功能.共有5例患者出现肌电反应,其中4例发生在椎管及神经根减压时,1例发生在复位矫形时.结论 ①胸、腰、骶椎结核患者术中联合运用SEP和TES-MEP监测,排除各种干扰因素后,能准确地反映术中脊髓功能状况,提高监护效果;②术中自发EMG监测可准确及时地反映神经根功能,避免腰骶部结核患者术中神经根损伤.%Objective To investigate the efficacy of combined monitoring of motor evoked potentials with transcranial electrical stimulation (TES-MEP),somatosensory evoked potentials (SEP) and spontaneous electromyo-graphy (s-EMG) in tuberculosis surgery involving the thoracic,lumbar and sacral vertebrae.Methods Twenty-seven patients with tuberculosis of the thoracic vertebrae (T2-L2) received intra-operative SEP and TES-MEP monito-ring.Combined SEP,TES-MEP and spontaneous EMG monitoring were employed in 11 patients with tuberculosis of the lumbar or/and sacral vertebrae (L3-S1).SEP and TES-MEP were used to precisely observe the status of the sen-sory and motor pathways; s-EMG responses were used to more accurately localize nerve root irritation.ResuIts (1) SEP monitoring was successful in all of the operations.TES-MEPs were successfully monitored in 35 of them (92.1％).Combined motor and sensory monitoring was successfully achieved in 35 cases (92.1％).Abnormal SEPs were observed in 3 cases (7.9％),while abnormal MEPs were observed in 11 cases (28.9％).Abnormality in both the SEP and TES-MEP occurred in 2 cases (5.3％).There were 9 cases (23.7％) where the SEPs were nor-mal and the TES-MEPs were abnormal.In only 1 case (2.6％) was the SEP normal and the MEP abnormal.The false negative rate was 0％ with combined SEP and TES-MEP monitoring,while the false positive rate was 5.3％.There were 2 cases complicated by post-operative neurological deficits.(2) Spontaneous EMG monitoring can accu-rately determine the functioning of lumbar nerve roots during lumbar or lumbosacral tuberculosis surgery.Among 5 cases where EMG responses were observed,4 cases occurred during the spinal canal and nerve root decompression,1 case occurred in the orthopedic reset phase.Conclusions (1) During tuberculosis surgery involving thoracic,lumbar or sacral vertebrae,combined monitoring of SEPs and TES-MEPs can reflect the physiological and pathological condition of the spinal cord after ruling out interfering factors.This can improve monitoring and help assure the safety of lumbar surgery.(2) Intra-operative s-EMG monitoring can accurately reveal nerve root function in real time,help-ing to avert nerve root injury in lumbar and lumbosacral tuberculosis surgery.
